Synopsis
Classify persistent or episodic abdominal pain by pattern, identify inflammatory, malignant, metabolic and gynaecological warning features, and make a positive, reviewable diagnosis without indiscriminate testing.
- Describe duration, episodic versus continuous course, exact relation to defecation, meals, posture, movement, menstruation and medicines before attaching a diagnostic label.
- Weight loss, iron-deficiency anaemia, rectal bleeding, nocturnal symptoms, fever, mass, family cancer history, persistent vomiting and older-age new onset shift the pathway towards prompt investigation.
- A positive diagnosis of irritable bowel syndrome rests on a compatible symptom pattern, limited exclusion tests and absence of warning features; it is not a synonym for all unexplained pain.
Key red flags
Unexplained weight loss, iron-deficiency anaemia, rectal bleeding, persistent change in bowel habit, abdominal or rectal mass and relevant age or family history require the current suspected-cancer pathway even when pain is longstanding.
Investigation priorities
Detect anaemia, iron deficiency, thrombocytosis or other evidence that changes inflammatory and cancer probability.
Management branches
Abdominal pain has persisted or recurred over weeks to months.
- Build a symptom timeline linked to stool, meals, movement, menstruation and medicines, and document weight, nutrition and functional impact.
- Actively seek bleeding, anaemia symptoms, nocturnal disturbance, fever, vomiting, mass, family history and a recent qualitative change from baseline.
Key medicines
Antispasmodic for IBS-type painUse a time-limited trial at the current BNF dose chosen for the individual preparation, then continue only if a meaningful benefit is demonstrated.
Low-dose tricyclic neuromodulatorStart below antidepressant dosing at night and titrate slowly under the current NICE and BNF approach, reviewing benefit and adverse effects regularly.